Hazards of parenteral treatment: do particles count?

• Published in: Archives of disease in childhood Vol. 67; no. 12; pp. 1475 - 1477
• Main Authors: Puntis, J W, Wilkins, K M, Ball, P A, Rushton, D I, Booth, I W
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.12.1992; BMJ
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arteritis - etiology; Arteritis - pathology; Autopsy; Biological and medical sciences; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Female; Granuloma, Foreign-Body - etiology; Granuloma, Foreign-Body - pathology; Humans; Hypertension, Pulmonary - complications; Hypertension, Pulmonary - pathology; Infant, Newborn; Intensive care medicine; Medical sciences; Parenteral Nutrition, Total - adverse effects; Particle Size; Pulmonary Artery - pathology; Sudden Infant Death - pathology; Human; Granuloma; Respiratory disease; Pathogenesis; Lung; Fat emulsion; Cardiovascular disease; Infant; Pulmonary hypertension; Parenteral administration; Feeding; Arteritis; Particle; Vascular disease; Arteriopathy; Complication
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.67.12.1475

After prolonged parenteral nutrition a 12 month old infant died with pulmonary hypertension and granulomatous pulmonary arteritis. A review of necropsy findings in 41 infants who had been fed parenterally showed that two of these also had pulmonary artery granulomata, while none of 32 control patients who died from sudden infant death syndrome had similar findings. Particulate contaminants have been implicated in the pathogenesis of such lesions and these were quantified in amino acid/dextrose solutions and fat emulsions using automated particle counting and optical microscope counting respectively. Parenteral feed infusions compounded for a 3000 g infant according to standard nutritional regimens were found to include approximately 37,000 particles between 2 and 100 microns in size in one day's feed, of which 80% were derived from the fat emulsion. In-line end filtration of intravenous infusions may reduce the risk of particle associated complications. A suitable particle filter is required for use with lipid.